As the United States continues to grapple with a growing mental health crisis, millions are finding it increasingly difficult to access and afford mental health treatment. Recent investigations conducted by the New York Office of the Attorney General (“OAG”) have uncovered a disturbing trend known as “ghost networks” that exacerbates this issue. Through mental health hearings, complaints to the New York Health Care Bureau Helpline, and comprehensive surveys, the OAG recently published a comprehensive report describing a significant gap in the availability of mental health services across the state, and it is likely that the OAG’s findings are applicable to other states.

According to the report, one of the major obstacles facing those seeking mental health treatment is the presence of inaccurate provider directories or unavailable providers, commonly referred to as “ghost networks.” These ghost networks hinder consumers from accessing treatment using their health insurance benefits, often forcing them into the challenging decision of paying out of pocket or going without essential care, with potentially dire consequences for their mental health.

To quantify the scale of this problem in New York State, the OAG conducted a sweeping statewide “secret shopper survey” involving 13 health plans. These included well-known names such as Aetna, CDPHP, Cigna, and UnitedHealthcare. As part of this investigation, directories were scrutinized, and inquiries were made to at least 20 providers in major cities served by the plans, including New York City, Albany, Buffalo, and Rochester. Callers aimed to schedule appointments with mental health providers listed as accepting new patients.

The survey unearthed shocking findings. Success rates for the 13 health plans ranged from 0% to a mere 35%. Among the 396 providers contacted across all plans, callers secured appointments only 14% of the time, which means that a staggering 86% of the listed, in-network mental health providers were essentially “ghosts” — unreachable, not in-network, or not accepting new patients.

Ghost networks are not only problematic but also illegal. Both state and federal laws mandate the maintenance of accurate provider directories. More specifically, commercial health plans, Qualified Health Plans (“QHPs”) issued under the Affordable Care Act, and Medicaid plans are required to maintain accurate online provider directories. The No Surprises Act also requires that all private health plans maintain accurate online provider directories, verify their directories at least every 90 days, and post any changes to these directories within two business days.¹ Plans must also apply in-network cost sharing for covered services provided by providers inaccurately listed as in-network.² Furthermore, CMS regulations require QHPs to publish an up-to-date, accurate, complete, and accessible provider directory, noting each provider’s location, contact information, specialty, institutional affiliations, and whether new patients are accepted.³ Finally, effective July 1, 2025, Medicaid fee for service⁴ and managed care plans⁵ must maintain accurate provider directories that indicate whether providers are accepting new patients.

The results of the OAG investigation highlight the barriers that many patients face when seeking essential mental health treatment. To that end, the OAG recommended a variety of regulatory changes, increased enforcement, and significant action by health plans, including:

• Require health plans to conduct regular audits of their provider networks (including secret shopper studies) to verify compliance with directory accuracy, network adequacy, and mental health parity requirements, and to report the results to regulators, who would make them available on a public website.
• Mandate robust appointment wait time standards for mental health treatment, so that consumers can promptly get the services they need.
• Require health plans to analyze and submit to regulators data regarding key network adequacy indicators.
• Require health plans to improve inadequate networks, ensure that network providers are culturally and linguistically competent, and improve consumer complaint mechanisms.
• Vigorously enforce the law and impose consequences for violations, including monetary penalties.
• Explore the possibility of a centralized provider directory for all health plans, which may improve compliance with regulations and access to treatment.

For more information and to access the full OAG report, please click here.

[1] 42 U.S.C. § 300gg-115(a), which is effective for plan years beginning on or after January 1, 2022. Although regulations have not yet been issued, plans must implement the requirements. Dep’ts of Labor, Health and Human Servs., and the Treasury, FAQs About Affordable Care Act And Consolidated Appropriations Act, 2021 Implementation Part 49 8 (Aug. 20, 2021), https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-49.pdf.
[2] 42 U.S.C. § 300gg-115(b).
[3] 45 C.F.R. § 156.230(b)(2).
[4] 42 U.S.C. § 1396a(83).
[5] 42 U.S.C. § 1396u-2(a)(5).